ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The effect of gender on specific joint biomechanics during gait has been largely unexplored. Given the perceived, subjective, and temporal differences in walking between genders, we hypothesized that quantitative analysis would reveal specific gender differences in joint biomechanics as well. Sagittal kinematic (joint motion) and kinetic (joint torque and power) data from the lower limbs during walking were collected and analyzed in 99 young adult subjects (49 females), aged 20 to 40 years, using an optoelectronic motion analysis and force platform system. Kinetic data were normalized for both height and weight. Female and male data were compared graphically and statistically to assess differences in all major peak joint kinematic and kinetic values. Females had significantly greater hip flexion and less knee extension before initial contact, greater knee flexion moment in pre-swing, and greater peak mechanical joint power absorption at the knee in pre-swing (P< 0.0019 for each parameter). Other differences were noted (P< 0.05) that were not statistically significant when accounting for multiple comparisons. These gender differences may provide new insights into walking dynamics and may be important for both clinical and research studies in motivating the development of separate biomechanical reference databases for males and females.

ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The purpose of this study was to determine rates of pneumonia and hospitalization for patients receiving oxygen therapy, patients having indwelling tracheostomy tubes, and those using tracheostomy or noninvasive methods of home mechanical ventilation. Six hundred eighty-four users of assisted ventilation for 13,751 patient-years or 19.8 years per patient were surveyed by mail and twice by telephone over a span of four years. Pneumonia and hospitalization rates were significantly higher for ventilator users with chronic obstructive pulmonary disease or with neuromuscular ventilatory insufficiency and gastrostomy tubes than for ventilator users with neuromuscular ventilatory insufficiency without gastrostomy tubes. Of the latter group, more than 90% of the pneumonias and hospitalizations were triggered by otherwise benign intercurrent upper respiratory tract infections. Oxygen therapy was associated with a significantly (P< 0.001) higher rate of pneumonias and hospitalizations than that seen for untreated patients after initial episodes of respiratory distress or during the use of either tracheostomy intermittent positive pressure ventilation or noninvasive ventilatory assistance methods. The lowest pneumonia and hospitalization rates (P< 0.001) were by full-time, noninvasive intermittent positive pressure ventilation users. We conclude that oxygen therapy is not an effective substitute for assisted ventilation for patients with primarily ventilatory insufficiency. Noninvasive ventilatory aids can be used effectively for up to full-time ventilatory support for patients with neuromuscular conditions whose bulbar muscle function is adequate to avert the need for gastrostomy tube placement.

ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

To understand how exercise affects the contractile function of dystrophic muscle, we examined the effect of long-term voluntary exercise onmdxmice and related these effects to our findings in sedentary aging mice. Although the mdx mouse is the genetic homolog for Duchenne muscular dystrophy, it does not demonstrate the same progression in limb muscle dysfunction as Duchenne muscular dystrophy as it ages. We postulated that the sedentary lifestyle of this animal plays an important role in its minimal phenotypic expression. To examine the effect of exercise, eight C57BL/10 (C57) and eightmdxmice were allowed to run ad libitum for one year. Forty sedentarymdxmice and 40 sedentary C57 from one month to 18 months of age were used as controls. Contractile characteristics of the extensor digitorum longus and soleus muscles and morphometric characteristics of the mice were examined. Themdxmice ran approximately 45% fewer kilometers per day than C57 mice. Long-term voluntary running had beneficial training effects on both the oldmdxmice and their C57 controls. The exercise ameliorated the age-associated loss in tension production that was observed in the soleus of sedentarymdxand sedentary C57 mice. There was a 9% reduction in the fatigability of the extensor digitorum longus muscle of the oldmdxmice after the exercise. Despite these improvements, the oldmdxmice exhibited significant functional deficits compared with their C57 controls. Our hypothesis, that long-term voluntary exercise would have a beneficial training effect on control mice and a deleterious effect onmdxmice as they aged, was not supported by this study. This study shows that dystrophin-less muscles from sedentary mice display significant signs of muscle damage, yet can respond beneficially to low-level voluntary running in a manner similar to that of the C57 control.

ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

We evaluated the pattern of osteoporosis after spinal cord injury, determined the time-frame of the changes, and elucidated the relationship among parathyroid hormone levels, biochemical markers of bone formation, and the pattern of bone mass loss. We included 176 subjects with spinal cord injury and 62 subjects without spinal cord injury as controls in the study. Bone mineral density of the spine and the proximal femur was measured. The participants' age, level of injury, and length of time since injury were compared with the nonspinal cord-injured controls and with each other. Serum levels of calcium, calcitonin, biochemical markers of bone formation, and parathyroid hormone were determined. Our results revealed that bone mineral density of the proximal femur declined and reached fracture threshold at one to five years after injury. The decline was detected at 12 months after injury in all age groups. Spinal bone mineral density neither declined significantly nor reached fracture threshold. Parathyroid hormone levels declined before the end of the first year postinjury and increased at one to nine years postinjury in the 20− to 39-year age group. The increase correlated with the initial decline of bone mineral density of the proximal femur. Our studies in spinal cord-injured subjects revealed a pattern of osteoporosis similar to age and parathyroid dysfunction-related osteoporosis. No other correlation was detected between indexes of bone metabolism and bone mineral density measurements.

ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The Functional Independence Measure for Children (WeeFIM) was developed based on the FIMSM instrument to assess disability in children aged six months to seven years. Its reliability and validity have been studied, and normative data are available for American children. The WeeFIM instrument is potentially an internationally useful instrument, but data from other countries are lacking. The objectives of this study are to examine whether the WeeFIM instrument is applicable to Japanese children and to describe preliminary normative data. To study interrater reliability, we had two examiners assess 20 nondisabled children and calculated weighted kappas for individual item scores and intraclass correlation coefficients for total scores and motor and cognitive subscores. We then assessed 110 nondisabled children ages six months to seven years to obtain normative data and compared them with the American data. In 51 of these healthy children, we compared total WeeFIM scores with developmental ages as obtained with the Tsumori test, a standardized developmental test widely used in Japan to assess its concurrent validity. The weighted kappas were greater than 0.8, and the intraclass correlation coefficients were greater than 0.98. Total scores and motor and cognitive subscores increased with age, reaching a plateau at 60 to 72 months, which is similar to the American data. There were three patterns of chronologic changes in individual item scores: items showing high correlations with age (Spearman's rho > 0.8; grooming, dressing, memory, etc.), moderate correlations (0.8 > rho > 0.7; eating, bladder, comprehension, etc.), and lower correlations (0.7 > rho > 0.6; locomotion and chair transfer). Total scores correlated significantly with developmental ages (Spearman's rho = 0.938), but there was a discrepancy between each item score and the pass-or-fail patterns of the Tsumori test. This study demonstrated the applicability of the WeeFIM instrument to Japanese children with satisfactory reliability and validity and provided preliminary normative data for future studies.

ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Histologic studies of Charcot-Marie-Tooth disease, type I, show a contrast between the lesions of myelinated fibers and the normality of unmyelinated fibers. Conventional electrophysiologic tests only demonstrate the alteration of myelinated fibers but do not study unmyelinated fiber function. We present routine clinical tests that are easily available and effective for the evaluation of small unmyelinated fibers: thermal threshold testing for warmth to evaluate small C unmyelinated somatic fibers and sympathetic skin responses to evaluate small C unmyelinated sympathetic fibers. Five unrelated patients with a diagnosis of Charcot-Marie-Tooth disease, type I, confirmed by biopsy were investigated. All of these patients showed marked reduction or absence of motor and sensory conduction velocities and severe denervation at needle examination. By contrast, thermal threshold testing for warmth and sympathetic skin responses were normal, confirming the normality of small C unmyelinated somatic and sympathetic fibers. We conclude that these noninvasive tests are helpful in the diagnosis of Charcot-Marie-Tooth disease, type I.

ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Joint contractures have been one of the contraindications for use of functional electrical stimulation for standing in paraplegic patients. A simulation study using a three-segment link mechanical model of the human body was performed to calculate the muscle moments at the ankles, knees, and hips during standing with and without having joint contractures. The knee and hip angles were varied in 5° increments, whereas the ankle angles were varied in 1° increments. It was assumed that energy efficient posture was obtained with the least sum of the squared moments of the ankles, knees, and hips joints by the muscles. Ankles at 5° of dorsiflexion, knees at 0°, and hips at 15° of extension resulted in the most energy efficient posture without joint contractures. The muscle moments increased with the increase in angle of contractures. The joint contractures at ankle angles 6° of plantar flexion, knee angles 20° of flexion, and/or hip angles 20° of flexion produce a potentially unstable posture. These findings suggest that some degree of joint contractures can be tolerated in paraplegic patients using functional electrical stimulation for standing.

ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

As we learn more about the origins of coronary artery disease, research has begun to focus on its prevention. The purpose of this study was to determine if exercise stress testing of the offspring of our cardiac rehabilitation patients would be a useful adjunct to their general cardiac risk factor assessment. In addition, we sought to quantitate the number of cardiac risk factors they might have already accumulated. We determined the lifestyle and lipid profiles of 22 young, healthy subjects. Subjects underwent maximal multistage exercise stress tests. Eighty-six percent of subjects had two or more major risk factors for CAD, and 73% had contributory risk factors. Seventy-three percent of subjects also demonstrated hypercholesterolemia. Exercise testing did not induce ischemic changes on electrocardiography of any subject. Our research revealed that these offspring demonstrate an alarming number of coronary artery disease risk factors, even though exercise stress tests were negative.

ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID